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| quidgydog |
| quote: | Originally posted by DIDI
You're right it can be never ending and it might be just as easy if we just throw copies of the Age and the Sun at each other. :D
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Actually, to get unbiased, factual reports from any media source is damn near impossible as well. |
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| Trance Nutter |
| quote: | Originally posted by quidgydog
Actually, to get unbiased, factual reports from any media source is damn near impossible as well. |
Adelaide Advertiser being case in point. About 80-90% of their major stories have a clear agenda being pushed by the paper. |
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| aL_mAc |
there is truth in everyones arguments here, fark ive go so much to say on this... there is also no political bias in my stuff its all taken from my lecture notes
quidgy... having just completed an entire unit on this very topic i feel some passion in making people realise what is really going on with healthcare, its funding and its protocols!
DIDI, you wanna know why the subsidies are going to the private health care system? cos it saves the government more money long term!
by creating subsidys and rebates aswell as funding for the private system it is alleviating the majority of the strain on the public system. although that report you submitted was contradictorary to what im saying it doesnt take into account the population expansion in need of healthcare nor does it take into account the rising cost of treatments and staffing!
there is also the factor of medical rationing to take into account... not all treamtents or services are given equity across the system. this is hard to explain in such a short post!
also in saying we are becoming more like the US system i can see your point and what you are getting at however the US has a completely user pay system which is why everyone has health insurance! in the UK the NHS provides care for the ppeople there but due to the magnitude of the population and a host of other socio-economic and environmental problems it isnt working the way it is intended... (another story all together)
In australia our public system is a hybrid of both the american and NHS (UK) systems. medibank came about as an adaptation of a dutch or swiss model (i forget) for health in the mid 70's i believe and was phased out when the change of government came in around 1980. it was then reintroduced a little later in a new form medicare which was a more aptly version of medibank specific to the australian publics needs. it was designed to meet the needs of the trends in the population at the time (see census data circa 1972) and not for what it actually is. You cant predict the future 100% as the government has found out and thus they have had to make changes as they have gone through kinda like patch jobs in a wall.. however with the current trends in our population like i mentioned earlier it cannot sustain itself.
quidy you are 100% correct in saying that supply will never meet demand because of the needs and wants of the public as well as the funding available, which is where the rationing comes into play.
ive lost my point @ this stage so i will review and post again soon, it is late afterall.. good arguments/insight though!!
if anyone is interested i have a major paper on the topic if youd like to read it.. just pm me.. |
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| DIDI |
| Would certainly be interested in reading your paper. On the subsidy thing I have a lot more information on that and I think we come to different conclusions. But I'm always up for more information. By the way who are you and what have you done with our aL- mAc :) |
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| aL_mAc |
| quote: | Originally posted by DIDI
Would certainly be interested in reading your paper. On the subsidy thing I have a lot more information on that and I think we come to different conclusions. But I'm always up for more information. By the way who are you and what have you done with our aL- mAc :) |
hahaha hes been qwelled i took him hostage and hid him in the freezer heres some extracts i think are relevant to the topic!
The Australian health care system faces significant challenges in meeting the needs of older people in Australia in ensuing decades. The traditional lament is that our ageing population is driving health expenditure out of control. However, the key problem is that the health care system is a highly contested domain. Any solutions will therefore need to balance and integrate multiple perspectives to make most effective use of our finite resources. However it is important for each of us to know that we can make a difference in stretching the limited resources we do have through better integration, coordination and communication.
The basis behind any good Emergency care system is to get the correct response to the right patient within an appropriate timeframe. With the right decisions on initial care or management, and the outcome or destination for the patient, the solution will usually render the best possible outcome.
An efficient system will incorporate many different services and/or resources to facilitate this with minimal expenditure or loss. However, even with this in mind, there are also several key drivers that also need to be addressed when designing a community based emergency health (CBEH) system, especially if it were to meet the requirements of the Victorian population for the next 50 years.
Victoria is a richly diverse demographic encompassing many different cultures, religions and of course ages groups, and as such these parameters would have to be carefully incorporated into such a plan. The demographic is frequently changing, thus so are its needs. It is also an expanding population, with people working, living and settling in areas previously not greatly populated. As the need for emergency health care rises costs inevitably will too rise as a consequence. Funding and rationing to will become issues for such a service and this to must also play a large role into how a system is devised.
These issues only form a small part of the overall picture when looking at the designing of such a system but create a good starting point of investigation.
The Victorian health care system faces significant challenges in the coming years to meeting the needs of the older people in the community. Trends indicate that the population is not only getting older, but increasingly, more people are living longer (due largely to advances in medical technology & treatments). Interestingly also is that trends are showing that there will be proportionately less people to care for them due to a drop in fertility rates. This creates a huge dilemma when trying to design and health care system to meet these demands.
The Australian population in 1870 was markedly different from today. At the time the proportion of children under the age of 15 was approximately 42% of the total national population, more importantly though only 2% of the total population was over the age of 65. In 1997 however, 21% of the population was under the age of 15 and the population over 65 was 12%, 6 times greater than in 1870.1 With the advancements in medical technologies as well as disease prevention strategies that will be available in the future, it is predicted that the aged population will not only get larger but also become the very old (80+). By 2031 it is estimated that the total aged population will have increased by almost half from the 1997 figures, and that the very old (80+) will have doubled from estimates in the same year. This leads to 22.3% of the total population of Australia being over the age of 65. It is also predicted that one third of this aged population (the 22.3%) will be dependant due to some form of disability or illness placing great strain on the health system.1
By the time the year 2055 rolls around, the aged population (aged 65 years or more) of Australia will account for 30% of the total Australian population. Based on these figures and the demand on the current Victorian rural service, which currently carry out around 780 jobs per 1000 people annually for this age bracket, fast forwarding into the future, would see them doing well in excess of 350,000 jobs a year. A figure that with the rest of the population in mind is not currently sustainable.
In Victoria, the percentage of the total metropolitan population aged 70+ years is estimated to grow from 8 per cent to 10 per cent by 2010–11. Because older people use health services at a higher rate than younger people, it is very evident that the ageing of the population is expected to contribute to increasing demand for health services and consequently the demand for CBEH services (MAS annual Report).
As the population expands, so does the need for housing and living. Obviously the space for this is not limitless therefore urban expansion is a real issue when designing a CBEH system. This ‘sprawl’ can be attributed to many different factors including occupation, personal choice or varying socio-economic factors. More importantly however, is that a CBEH service must not only be available to its users, but it must also be readily accessible and swiftly. For this reason the scope of such a system must ideally have some locality in mind.
It is a reasonable assumption that ambulance demand is impacted greatly by the trends within the overall health system as well as increased demand as a result of ageing and increasing population. Demand of a service increases when there is a change in one or several key areas, which may include but may not be limited to
- Demographic Changes (population growth, ageing)
- Social Changes (people living alone, declining family support structures)
- Clinical & Epidemiological Changes (change in case types, morbidity patterns)
- Changes in Medical practice and patient management
- Quality and accessibility of alternative Services (decline in GP’s, bulk billing outlets etc)
- Community Expectations
It is therefore highly probable that by the time the year 2055 arrives that demand will have increased significantly in all aspects of health care. This in tern will also have to be addressed when designing a CBEH system for such a time.
Within the rural setting, transports of the elderly aged 70+ accounted for over 32% of jobs in some areas in 2001, if the ageing population trend is in line with the usage trends, which it appears to be, this number is set to escalate further and again place great strain on such a service (RAV Handout).
This is also backed up by a study conducted by the Department of Human services (DHS) called the Metropolitan Health Strategy (MHS). MHS has recommended 4 strategic directions for health services with respect to future demands of the Victorian population.10
1. Increase Capacity – adding capacity to the health system, particularly in areas with already poor local access to health services, this includes increasing hospital bed numbers and emergency department services.
2. Redistribute and Reconfigure Capacity – to make better use of existing facilities by improving facility design and function to meet changing patient needs in the future.
3. Service Substitution and Diversion – by promoting effective health care alternatives to reduce dependency on in-hospital services.
4. New Service Models – changing the way services are provided to improve service efficiency and increase continuity of care. Future clinical advances will be supported by the development and implementation of new models of care, including cancer services, mental health and services for older people.
Again there is one prevalent theme running through the MHS plan. That is how the aged population is going to affect the health care system and service delivery in the future.
As demand and use of a system increases, naturally so to does its running costs. The need for more resources, technology and maintenance aswell as staffing costs will all play a large role in the yearly running costs of a CBEH service. Unfortunately however money is not limitless and these costs must be accounted for in order for the service to be viable and sustainable. Funding plays the biggest role in this and as such must be also efficient and reliable.
Governmental policy reform and funding structures for this reason are going to be crucial in future years to ensure sufficient and accessible health care for all Australians.
Currently, the federal government funds health within the states using a policy known as the Public Health Outcome Funding Agreements (PHOGA). This put simply is a contract between the Federal Government and that state, which is then responsible for the running and delivery of its own public health care.
The allotment or budget of funding between the different States and Territories is based on a resource distribution formula which uses both horizontal fiscal equalisation and vertical fiscal imbalance. In addition to this, extra funding can be channeled to a disadvantaged state to ensure that no state or territory is worse off than another.4 If a state is not given enough funding to run their public health systems the additional funds are taken from there own derived income from state taxes.4
Possible reform to this system should recognise any imbalance and develop the jurisdiction on public health to make it the exclusive responsibility of the federal government. In theory, doing this should reduce cost cutting exercises, money handling responsibilities and costly inquiries into the use of federal funds. The money therefore saved can also potentially be put back into the public health budget.
From this funding, the individual budget of a Victorian CBEH system could be derived as a proportion. It would be in best practice if there was both an element of governmental grants to coincide with self funding exercises. A ‘budget’ with which to work and provide the basics of the service from the government could be coupled successfully with a self funding exercises such as a subscription scheme for example. This would allow for further expansion and education to help make the necessary improvements it needs to keep up with demands. The running of an efficient and economically viable system will also help facilitate this to occur.
The cost of healthcare in Victoria continues to rise at a steady rate; this costliness is driven by a number of factors which includes advances in technology, the ageing population, the propensity to be sued and the dwindling profit margins for providers. Obviously due to this not every resource can be used with every patient. This is where effective rationing plays a role.
Rationing simply can be defined as the allocation of healthcare resources in the face of limited availability. This means simply that beneficial interventions maybe withheld from some individuals. However a system should never make the mistake of trying to create an entirely inflexible system for resource allocation, clinical judgment will always be central to the decision making process. Patients differ widely, and any systematic approach to rationing that ignores clinical judgments would ignore important differences between individual cases or be so complex to be unworkable. Any systematic approach to rationing will necessarily be supplemented by decisions about how general rules can be reasonably applied to the patient in that particular setting.
No healthcare system can afford to provide all patients with all treatments that may have a potential for benefit, nor are there specific guidelines that indicate the optimal and equitable use of these treatments. Or, specifically to make decisions about how to allocate life-saving healthcare resources in ways that are rational and fair. |
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